Some form of ‘specific regulation’ for advanced practice in nursing and midwifery is needed, according to stakeholders informing a new study.
Independent research carried out by the Nuffield Trust and commissioned by the Nursing and Midwifery Council (NMC) found that experienced nurses and midwives are increasingly taking on complex, autonomous, and expert roles.
While the NMC does not currently specifically regulate advanced practice, as part of its 2020-25 strategy it has committed to considering whether additional regulation is needed.
Previously, the NMC has twice discussed the possibility of beginning work at demonstrating the need for regulating advanced practice, but did not take action.
This new research from the Nuffield Trust showed that the ‘consensus’ among stakeholders, which included nursing leaders at the highest levels, was that some form of specific regulation is needed for advanced practice in nursing and midwifery.
The most common reasons cited for needing additional regulation were to ensure a clear definition of what advanced practice is and thereby resolve inconsistencies and confusion over the role.
Researchers also highlighted: ‘Most nations with nurses working at a similar advanced practice level as nurses in the UK have specific advanced practice regulation.’
It said that a ‘cross-country comparison identified 11 countries with significant similar scopes of advanced practice as in the UK and, of these, Finland was the only other (alongside the four countries of the UK) to not specifically regulate advanced practice’.
However, there were also concerns raised within the study that introducing new legislation carried a very high financial burden and would force professionals to register a second time in order to continue in their current roles.
The researchers also heard concerns from stakeholders that there was a risk of ‘unintended consequences for other professional groups’ should the NMC pursue additional regulation for advanced practice.
Ultimately, the researchers concluded that the regulation of advanced practice ‘is highly complex and evolving’, requiring further investigation of the risk that advanced practice poses to people across the full range of current practice.
The researchers noted: ‘The trend is towards ‘light-touch’, rather than heavy-handed, regulation.’
Andrea Sutcliffe, NMC chief executive, said that the NMC’s governing council would be asked to ‘discuss these initial findings and how they’ll inform our next steps’.
‘This will include further lines of enquiry before we come to any conclusions on options for the future,’ she added.
‘It’s vital that we work closely with our partners, professionals and the public to coproduce any changes we may make.’
The regulator said its council would discuss the findings of this early research at its next meeting on 17 May.
Research findings also suggested great variation in the routes nurses take into advanced practice and in the roles they play across the UK.
There is currently no single definition of advanced practice, nor are there any consistent outcomes, or standards of education or proficiency, noted the study.
Advanced practitioners commonly undertake higher education such as a master’s degree, but there is significant variation in the courses and in the job titles awarded to nurses after graduation, it added.
The researchers found that in May 2022 there were more than 4,900 nurses and health visitors with a recorded job title of ‘advanced practitioner’ and a further 3,100 with a job title suggesting advanced practice.
Yet they also acknowledged that this could underestimate the true number of nurses working at the advanced level by as much as 8%, according to stakeholders informing the study.
The research also found that public understanding of advanced practice was ‘unclear’ and that ‘great national advocacy was needed.’
A previous survey conducted by the Association of Advanced Practice Educators found that over 40% of advanced practitioners thought patients did not understand their role.
